Diabetes

Question 1

T1 general info

Answer 1

autoimmune destruction of B cells in the pancreas
younger onset but consider ‘latent autoimmune diabetes of adults = LADA’
Autoantibodies = HLA - DQA and DQB
small hereditary risk 3-5%
typically present with weight loss, polyuria or DKA

Question 2

T2 general info

Answer 2

insulin resistance in the context of metabolic syndrome = central obesity + HTN + hyperglycaemia + dyslipidaemia
usually preceded by impaired glucose tolerance
Consider mature onset diabetes of the young MODY - rare autosomal dominant form of T2DM
Usually incidentally diagnosed/asymptomatically

Question 3

Complications of DM

Answer 3

Macrovascular:

• Cardiovascular disease (MI)
• Cerebrovascular disease (TIA/stroke)
• Peripheral vascular disease

Microvascular
Retinopathy
- cotton wool spots and haemorrhage, neovascularisation

Neuropathy

1. symmetrical sensory neuropathy (vibration>pain>temp) late stage loss of balance
2. Acute painful neuropathy -less common and remits with 3-12 months of control (burning pain at night)
3. mononeuropathy/mononeuritis multiplex = CN palsies, peroneal nerve (foot drop), median nerve (carpel tunnel)
4. Diabetic amyotrophy - painful asymmetrical wsting of quads, knee reflex decrease
5. Autonomic neuropathy -sweating, tachycardia, postural hypotension, atonic bladder

Nephropathy

• arteriolar disease, glomerulosclerosis, ascending infection
• microalbuminuria + proteinuria

Question 4

Sx of hyperglycaemia

Answer 4

Polydipsia, polyuria,
Unexplained weight loss 
Visual blurring 
Candida infection 
lethargy 
ketoacidosis

Question 5

investigations

Answer 5

• HbA1C
• BGLs
• Antibodies - islet cell antibodies, anti-GAD, Insulin autoantibody and I2A
• B-hydroxybutyrate in blood and ketones in urine = ketosis
• Urine ACR

Question 6

Management

Answer 6

Education
- diabetic nurse specialist

Lifestyle
- weight loss and diet

Pharm agents

Question 7

Complications of DM -treatment

Answer 7

Neuropathy

• Amitriptyline and Nortriptyline (Anti-chol SE: dry mouth, dry eyes, urinary retention, hypotension) Gabapentin, carbamazepine for pain
• orthotics and podiatry
• regular foot checks

Nephropathy

• control BP = ACE and ARB both reno protective and indicated when proteinuria is detected
• treatment of UTIs
• Dietary protein restriction
• peritoneal dialysis is better for ESRF in diabetics as HD can worsen retinopathy and almost always precede neuropathy

Autonomic dysfunction

• Hypotension - TED stockings
• Gastric paresis - metocloperamide or domperidone

Retinopathy

• 2 yearly ophthalmology review
• laser

MANAGE CVD risk

• control HTN
• control lipids + triglycerides
• smoking cessation
• anti-platelet